Non-invasive ventilatory support in neonates: An evidence-based update

Area of Science:

• Neonatology
• Pediatric Pulmonology
• Critical Care Medicine

Background:

• Non-invasive ventilatory support (NIV) is the gold standard for preterm infants with respiratory distress syndrome (RDS).
• NIV initiated at birth demonstrates superiority over mechanical ventilation (MV) in preventing mortality and bronchopulmonary dysplasia (BPD).
• Various NIV methods exist, with established efficacy for some and a need for further research in others.

Purpose of the Study:

• To review current evidence on NIV as primary support to prevent intubation.
• To evaluate NIV as secondary support following extubation.
• To discuss optimal NIV devices and interfaces for neonatal resuscitation.

Main Methods:

• Comprehensive review of existing research on different NIV modalities.
• Analysis of data comparing NIV to mechanical ventilation for RDS outcomes.
• Evaluation of patient interfaces and device suitability for neonatal respiratory support.

Main Results:

• Nasal continuous positive airway pressure (nCPAP) has largely replaced routine invasive MV for initial RDS management.
• NIV demonstrates a significant reduction in death or BPD, with a number needed to treat between 25 and 35.
• Selection of NIV method and interface is influenced by gestational age, lung condition, and available resources.

Conclusions:

• NIV is a crucial intervention for preterm infants with RDS, offering significant benefits over MV.
• Evidence supports the use of various NIV techniques, including nCPAP, for both primary and secondary respiratory support.
• Careful consideration of patient factors and available technology is essential for optimizing NIV delivery and neonatal outcomes.